Individual
LISA MARIE JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1418 TIGER DR, THIBODAUX, LA 70301-4337
(985) 449-4055
Mailing address
1418 TIGER DR, THIBODAUX, LA 70301-4337
(985) 449-4055
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7500
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
03/04/2018
Last updated
12/13/2022
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